Insurers provide more than $50 million in rebates

Insurers provided more than $50 million in rebates to Wisconsinites last year, according to recent federal data.

Overall, 121,272 Wisconsinites received an average rebate of $412.

Under a provision in the Affordable Care Act, if insurers in the individual or small group markets spend less than 80 percent of premiums on medical claims and other activities intended to improve care quality, they have to rebate excess dollars back to consumers. Large group plans must meet a medical loss ratio of 85 percent.

Most of the rebates in Wisconsin – $41.9 million – are heading to those served by the individual market. Per the data, 66,563 Wisconsinites with individual plans have received an average rebate of $629.

An additional 53,594 enrolled in small group plans have received an average $149 rebate, for a total of $8 million.

And 1,114 in the large group matter have received an average $159 rebate, for a total of $176,862.

Common Ground Healthcare Cooperative issued the most in rebates, providing $27.4 million to those in the individual market.

Children’s Community Health Plan refunded $12.8 million in the individual market. They issued checks to 11,930 households, with the average rebate being about $1,069 per subscriber, per the insurer.

UnitedHealthcare issued $6.7 million in the small group market and $227,018 through All Savers Insurance Company.

“Our goal in pricing is to cover the costs of medical care, ensuring sustainability and providing individuals with access to a range of coverage options,” a UnitedHealthcare spokesperson said. “When we do not meet that threshold, we pay a rebate.”

WPS provided $1.7 million in the individual market, for an average of $1,460 for 1,191 policy holders, per the company. For the small group market, it paid $749,834 to 603 employers, for an average of $1,243 per employer.

Network Health Plan provided $317,645 in the small group market. Spokeswoman Jessica Fischer said the rebates helped support local businesses facing challenges from the COVID-19 pandemic.

Cigna provided $176,862 in the large group market, and The United States Life Insurance Company in the City of New York, owned by AIG, provided $26,574 in the individual market.